An Examination of Nutritional Approaches and Stress Erkut Tutkun

1 Faculty of Sport Science, Uludag University, Bursa/Turkey - E-mail: erkuttutkun@uludag.edu.tr

Summary.Summary For athletes, nutrition is very important not only for sporting success but also with re-gard to health. The aim of this study is to determine nutritional approaches and stress levels in athletes. A total of 420 athletes aged 17-24, studying at Ondokuz Mayıs University, took part in the study. The participants’ BMI was calculated from their age, height and body weight, and a nutritional approach test questionnaire and perceived stress scale were applied. For the statistical evaluation, student t-test, one-way variance analysis and LSD tests were used. The average ages of the students were 22.13 for females and 22.85 for males. BMIs were determined as 22.00 kg/m2 for females and 24.15 kg/m2 for males. Nutrition scores were calculated as 16.49 for females and 18.06 for males. In the nutrition questionnaire, according to the gender of the students evaluated, no statistically significant difference was determined among ages (p>0.05), whereas statistically significant differences were determined among heights, body weights and BMI values (p<0.001). While the differences between athletes’ nutrition scores were not found to be statistically significant according to gender (p>0.05), the total score distributions in the nutritional approach test were found to be statistically significant according to BMI (p<0.05). 87.7% of the athletes believed that they had the correct body weight for the sport that they played. In the stress category, the nutrition score was 21.4 in the group with stress scores of 20 and below, while the nutrition score decreased to 16.48 in the group with stress scores between 21 and 30. The nu-trition score in the group with stress scores over 30 was determined as 13.85. It was established that nutrition scores differed significantly according to stress category (p<0.05). In conclusion, it was found that both male and female athletes’ nutritional approaches were at a good level, and that as stress levels decreased, nutrition scores increased. It can be said that the athletes’ nutritional knowledge and behaviours were at adequate levels. It is recommended that further information is given with regard to nutrition, health and stress reduction.

Keywords: Sport, athletes, nutrition

Progress in Nutrition 2020; Vol. 22, N. 3: e2020005 DOI: 10.23751/pn.v22i3.8409 © Mattioli 1885

O r i g i n a l a r t i c l e

Introduction

Nutrition is defined as conscious behaviour with which the correct nutrients are consumed for main-taining a good quality life and for preserving and im-proving health. Nutrition for athletes, however, means that athletes consume nutrients in an adequate and balanced way in accordance with their gender, age and daily physical activity, by making conscious adjust-ments during their training and competition periods according to the branch of sport that they play (1).

Proper nutrition is an important part of sport per-formance for young athletes, in addition to allowing for optimal growth and development. Macronutrients, micronutrients and fluids in the proper amounts are essential to provide energy for growth and activity. To optimize performance, young athletes need to learn what, when and how to eat and drink before, dur-ing and after activity (2-3). Research supports that proper nutrient intake corresponds to peak physical performance and that nutrient deficiencies may lead to diminished athletic performance. In the past, only

E. Tutkun2

elite athletes were concerned with the role of nutri-tion in athletic performance. Today, most athletes understand that proper fuelling through optimal nu-trition is an important and integral part of a training program. Nonetheless, most collegiate athletes remain poorly educated about sound nutritional practices and are unskilled in making appropriate daily nutritional choices (4). An athlete will try to meet his/her nutri-tional needs outside camps with his/her own knowl-edge and means. Therefore, the information habits that he/she forms with regard to nutrition must be based on healthy foundations (5).

Athletes do not demonstrate a sufficient knowl-edge of nutrition for their performance needs despite a reported high interest in nutrition. In general, athletes tend to obtain nutrition information from magazines, health food store personnel, coaches, gym owners, teammates, parents, supplement manufacturers and other athletes. Due to the fact that athletes know that they have unique nutritional needs, they often seek guidance or accept prescribed diets. They tend to turn to resources other than health professionals, which may lead to continued lack of good nutrition educa-tion. Unfortunately, many of these sources are not suit-able, and at times the information imparted is unreli-able and only adds to the myths surrounding nutrition that may affect athletes’ diet (3, 7). One of the primary strategies for assisting athletes to consume an adequate diet is the provision of nutrition education. The aim of diet education is to address the need for athletes to know what to eat and how to select and prepare a wide variety of foods necessary for a healthy diet (8, 9). For this reason, appropriate information regarding diet should be provided to athletes so they can make healthy food choices (3).

Nutrition knowledge is also influenced by beliefs about food and nutrition, which may not be evidenced based but rather steeped in cultural or present secular thinking (11). Evolving nutrition research, food prod-uct advertising, the complexity of behaviours needed to achieve healthy eating and strong media and Internet coverage of nutrition issues make it challenging for clear nutrition messages to translate at a population level (8).

Although individual physiological and psycho-logical factors, training status, nutrition status, health, environmental factors and sport-specific character-

istics all play a role in the achievement of high-level sporting performance, it is difficult to say which factor is more effective in maximum performance. However, it is an undeniable fact that it is impossible for an ath-lete who does not have a correct and good-quality diet to expect high performance (12). An appropriate diet for an athlete aims to not only maximize exercise ca-pacity and performance during competition but also promote physiological adaptations to training, assist in recovery and protect immune function and overall health. Modifications to dietary intake can alter body composition which is also required by most athletes to enhance performance (9). At the same time, timely determination of regular physical activities and nutri-tional habits made during childhood and adolescence, and attempts to adjust those that are negative (13) can be transformed into a healthy and good-quality phi-losophy of life.

To develop health education and health promo-tion initiatives targeting students, it is important to have detailed knowledge about the health of students and their health related behaviours, and factors that influence these such as knowledge, attitudes, personal resources, motivation for a healthy lifestyle and social support (14). Correct dietary habits not only add posi-tive value to physical appearance in athletic and sed-entary young people, they can also facilitate fulfilment of metabolic needs, acquisition of a healthy frame of mind and coping with sources of stress.

There is widespread scientific acceptance of a re-lationship between psychological stress and eating be-haviours and increased or decreased intake of food (15, 16). In research on eating disorders, stress is consid-ered as a factor that might disturb food intake regula-tion, and is usually analysed in relation to individual differences in weight or dietary restraint (17).

Stress is a term that is used to define the body’s physiological and/or psychological reaction to cir-cumstances that require behavioural adjustment (18). Stress is formed as pressure and anxiety and the situ-ation of trying to protect inner balance. Stress is the cause of mental and physical tension. The perceived levels of stress are determined in relation to how peo-ple give meaning to them and how they give explana-tions for them (19). Overall, perceived stress is linked to reduced life satisfaction (20).

An examination of nutritional approaches and stress 3

Increased stress levels have negative consequences on both the body and the mind. Some of the psycholog-ical problems that can occur secondary to stress include anxiety, depression, and engagement in high-risk be-haviour. Furthermore, the physiological health problems that can occur are numerous, as stress, through increased cortisol secretion, promotes increased food intake, espe-cially intake of sweet and nutrient-poor foods. Hence, increased stress may increase the risk of obesity and its comorbidities, which include hypertension, metabolic syndrome, heart disease and diabetes (21).

Especially in athletes who are physically active, in order to compensate for the high energy consumption resulting from exercise, the acquisition of healthy di-etary habits is essential not only for sporting success but also in terms of physical, physiological and psycho-logical health. This study was conducted with the aim of examining athletes’ dietary habits and stress levels.

Materials and Methods

A total of 420 athletes aged 17-24, studying at Ondokuz Mayıs University, took part in the study. The participants’ BMI was calculated from their age, height and body weight, and a nutritional approach test ques-tionnaire and perceived stress scale were applied. The questionnaires were applied to participants who were actively involved in a branch of sport. Questionnaires that were incompletely or incorrectly filled in were ex-cluded from the evaluation. Voluntary consent forms were obtained from the participants, in which they were informed about the aim and content of the study.

Nutritional habits questionnaire: the question-naire consists of 12 questions. In preparing the survey questions, questions whose validity had been estab-lished in previous studies on the subject were utilised. Scores of 0, 1 and 2 are given according to the answers given to the questions in the scale, and the scores are added up. If the distribution of scores in the nutrition-al approach test questionnaire is between 0-8 points, then dietary habits definitely need to be improved. A score of 8-15 indicates that small changes in dietary habits need to be made. If the score is between 15-25, then dietary habits are generally good. A score of 24 can be considered as perfect (22).

Perceived stress scale: This scale was adapted to Turkish society by Bilge et al. (2009). Each item in the scale has a score of 1 to 5, which comprises 10 items. Thus, the items are scored from 1-5 points, and these are never (1 point), almost never (2 point), some-times (3 point), fairly often (4 point), and very often (5 point). The scale consists of 10 items and is easily understandable. Four items, 4,5,7 and 8, are scored as positive, while six items, 1,2,3,6,9 and 10, are scored as negative. It is possible to obtain a total score from 0 to 50. The primary purpose of the scale is to meas-ure levels of stress. A high total score means that the perceived level of stress is high (24). In the present study, the perceived stress scale had internal consist-ency (Cronbach’s alpha) of α=0.77).

Statistical Analysis

SPSS 21 software package was used for the statistical data. The Kolmogorov-Smirnov test was performed to test whether the data were normally distributed or not, and it was determined that the data showed normal distribution. Independent t-test and one-way variance analysis were used, and to determine the groups that were different, the LSD test was used. Significance level was accepted as p<0.05.

Results

The data obtained in the study are presented below.

Discussion

Assessment of nutrition knowledge and its impact on dietary intake is important for the development and evaluation of nutrition education for athletes. The present systematic research examined the relationship between nutrition knowledge, dietary intake and stress in university students. In the study, the findings were discussed in order. However, the link between nutri-tion knowledge and dietary intake is complex and may be influenced by many other factors including taste and food preference, and cultural, religious, and family

E. Tutkun4

beliefs (25). Nutrition education programmes are de-signed to improve nutrition knowledge, with the aim of supporting sound dietary intake within the commu-nity or a specific target population (26).

In the present study, the aim of which was to reveal the nutritional approaches and stress status of university students who play sports, it was determined that the average age of students in sports science was 22.13 for females and 22.85 for males; that their aver-age heights were 164.22 cm for females and 173.14 cm for males; and that their body weights were 59.18 kg for females and 72.29 kg for males.

Nutrition scores were revealed as 17.06 points for females and 17.49 points for males (Table 1). Accord-ing to the results of the nutrition questionnaire evalu-ation, while no statistically significant differences were observed in age or nutrition scores according to gen-der (p>0.05), statistically significant differences were found in height, body weight and Body Mass Index values according to gender (p<0.001).

In a study by Vançelik et al. (2007), it was re-vealed that mean dietary habit scores and mean dietary knowledge scores were higher in male university stu-dents than in female university students (27). Ermiş et al. (2015), in a study conducted with students in health-related departments, found that students in these departments were better informed about health and nutritional habits than students in other depart-ments (28). Moreover, in Akıl and Gürbüz’s (2010) study, it was determined that there were significant differences in dietary knowledge levels of national and non-national athletes (p<0.001) (29).

In the study, it was revealed that 35% of athletes had taken nutrition classes, while 65% had not, and that there was a significant difference between those who had received nutrition education and those who had not. In a study by İmamoğlu and colleagues (2010), differences were found between nutrition scores of students studying in the physical education and sport department and those studying in different branches who were actively involved in sport, and this situa-tion was evaluated as the fact that the athletes’ food consumption levels were below the required amount and that they had incorrect dietary habits (30). In a study by Yahia and colleagues (2016), the total score for the nutritional knowledge section was 8, and the

mean score for females was 5.5 ± 1.28 and for males, 5.1±1.31 (p=.053) (31). In another study, Koç and Türkçapar (2015) revealed that wrestlers paid atten-tion to their diets and were aware of the importance of nutrition for success in sport (32). In their study, Şener and İmamoğlu (2018) stated that the nutritional level of students receiving sports education was “good” (22).

The mean nutrition questionnaire scores of the participants were determined as 17.06 for females and 17.49 for males. Examining the questionnaire evalua-tion scores in the study, it is seen that a score of 15-24 points was assessed as that “dietary habits are generally

Table 2: Total score distribution for nutritional approach test questionnaire according to Body Mass Index

BMI n Mean sd F/LSD

20 and under (1) 41 14.01 2.063.68*

1.4<2.3

21-23 (2) 167 20.21 2.07

24-26 (3) 114 20.22 2.07

27 and over (4) 98 14.57 2.04

p<0.05

Table 3: Nutrition scores of sedentary women according to stress pointsStress points category n Mean sd F/LSD

20 points or under (1) 240 21.4 2.16 3.27*

1>2>321-30 points (2 ) 111 16.48 2.14

Over 30 points (3) 69 13.88 2.21

Total 420 17.25 2.21

Table 1: Age, height, body weight, BMI and nutrition scores according to gender

Gender n Mean sd t

Age (years)Female 205 22.13 3.67

0.25Male 215 22.85 3.28

Height (cm)Female 205 164.22 5.53

-10.21**Male 215 173.14 5.88

Body weight (kg)Female 205 59.18 7.69

-10.12**Male 215 72.29 8.21

BMI (kg/m2)Female 205 22.00 3.18

-7.69**Male 215 24.15 3.29

Nutrition scores Female 205 17.06 2.07

0.34Male 215 17.49 2.07

** p<0.001

An examination of nutritional approaches and stress 5

good, but not perfect” (22). According to the results obtained in the study, the students’ nutritional habits can be regarded as “good”. The results of the afore-mentioned study support our own research findings. It is known that receiving nutrition education has a posi-tive effect on nutritional knowledge. In the study, the fact that the athletes’ nutritional habits were good, as well as the fact that no difference was found between their nutrition scores, that the athletes were students in the sports science faculty and that in these depart-ments, they had taken classes related to the field of nutrition and health, may be considered to show that they were sensitive towards and gave importance to the subject. Nevertheless, it can be said that some partici-pants also needed to make small changes to their diets.

In the present study, Body Mass Indexes were determined to be 22.00 kg/m2 in females and 24.15 kg/m2 in males. A statistically significant difference was determined in the distribution of total scores in the nutritional approach test according to Body Mass Index values (p<0.05). Al-Rethaiaa and colleagues (2010), in a study conducted on Saudi Arabian univer-sity students (n=357) with average age of 20.4±1.3, av-erage height of 168.8±6.1 cm and average body weight of 69.9±15.6 kg, determined that the participants had a mean BMI value of 168.8±6.1.

In Lebanon, the prevalence of overweight and obesity among male college students was 37.5% and 12.5%, respectively. In Kuwait, the corresponding percentages were 32% and 8.9%, while in the United States and the United Arab Emirates overweight and obesity accounted for about 35% of male college stu-dents. In contrast, only 7.9% of Iranian male college students were above the normal body weight. That rate decreased to 2.9% among Chinese college students with a percentage of obesity as low as 0.4% (33). In the study by Türkmen and İmamoğlu (2016), a statistically significant difference was determined in the distribu-tion of scores in the nutritional approach test according to Body Mass Index (34). In Güneş and Ersoy’s (1997) study with active athletes, mean Body Mass Indexes were determined to be within the recommended lim-its, at 24.65±0.43 kg/m2 in males and 21.34±0.71 kg/m2 in females (35). According to Body Mass Index, while those over 25 kg/m2 are not accepted as normal with regard to health, a value of 26 kg/m2 can be ac-

cepted as normal for athletes due to their high muscle mass (30). The fact that the numbers of participants in the group with mean BMI values of 20 kg/m2 and under and of 27 kg/m2 and over were lower than the numbers in the group with values of 21-23 kg/m2 and 24-26 kg/m2 can be interpreted as that participants in that group paid less attention to their diets.

In the present study, when nutrition scores ac-cording to stress category were examined, it was seen that while the nutrition score in the group with stress scores of less than 20 was 21.4, the nutrition score in the group with stress scores between 21 and 30 fell to 16.48. The nutrition score in the group with stress scores of over 30 was determined as 13.85. It was re-vealed that nutrition scores differed significantly ac-cording to stress category (p<0.05).

It is known that perception of stress can be affect-ed by many personal and environmental factors (23). In the study by Deryahanoğlu and colleagues (2016), it was determined that there were significant differences in perceived stress, depression, and the way a person perceived his/her body, according to whether partici-pants did sport or not (19). In their study, Yamak and colleagues (2016) stated that increasing sporting events during the development of adolescents and participa-tion in these by adolescents contributed to their de-velopment (36). In the study conducted by İmamoğlu and colleagues (2018), the stress levels of university students receiving sports education was found to be low (37). In a study made by Ekici (2013), it was deter-mined that students’ appetite levels changed in states of joy or unhappiness, and that especially when they were unhappy, their appetite for food was shown as a negative diet preference (38). Excess eating is fre-quently associated with emotional stress. These people eat a lot of food in a short space of time and while do-ing this, they lose control (39). In another study, it was stated that with regard to suppressing emotions, indi-viduals can consume an excess amount of the food that they love and that regulating their emotional state has a positive effect on their eating behaviours (40). Van Strien and colleagues (2013) revealed that individuals with a tendency for emotional eating preferred sweet food to salty food (41).

Eating behaviour is observed in the majority of obese patients after distress, unhappiness and irritabil-

E. Tutkun6

ity (42). This type of behaviour can be regarded as peo-ple’s being easily affected by life events and not form-ing sufficient defences against these. We can say that as stress scores increase or as people’s state of stress increases, nutrition scores decrease. The results of this study support the idea that adolescents’ psychological wellbeing is related less to their real or observable ex-cess weight than to their satisfaction with their body image (43).

In the present study, 87.7% of the students stated that they had the correct body weight for the branch of sport that they played, while only 12.3% regarded themselves as fat or thin. In a study carried out in America on adolescents, 61.0% of participants stated that they were not satisfied with their bodies and that they wished to be slimmer (44). Şener and İmamoğlu (2018) reported that 88.9% of students receiving sports education had the correct body weight for the sport that they played (22). In similar studies conducted in Turkey, it was reported that 76.4% of students wished to gain or lose weight and were not happy with their weight, and that those wishing to lose weight were in the majority (63.2%) compared to those that wanted to gain weight (45). In another study, it was revealed that 56.0% of participants were not satisfied with their gen-eral appearance and that 89.0% wished to lose weight (46). Over half of the study group (54.0%) regarded themselves as having a normal weight, while the re-mainder either considered themselves as thin (23.9%) or overweight/fat (22.1%). In a study made with ado-lescents, it was determined that 43.0% of individuals tried to lose weight, while 19.0% of them tried to pre-serve their current weight (47). In another study, it was revealed that 29.9% of the study group wanted to be slimmer (48). In a study conducted by Kaneko and col-leagues (1999), it was stated that 84% of girls aged 17 described themselves as “fat” or “very fat”, that 32% of girls with an approximately 90% standard body weight performed different practices to lose weight, and that Japanese adolescent girls gave increased importance to their body weight, figure and slimming as their adoles-cence progressed (49). When an athlete with a body weight above normal is compared with an athlete whose weight is within the recommended limits, it is seen that the former needs to spend more energy for the same endeavour and that he/she exerts more spare power. In

other words, a fat person is able to make a specific body movement only by spending more energy (50).

In the present study, the findings revealed that the majority of participants were satisfied with the body weight that they had, and that there were fewer par-ticipants who wished to lose weight. Dietary habits are established in early life and can have a considerable ef-fect on the health of individuals in the long-term (51). The fact that our participants had correct body per-ceptions with the body weights that they had supports the idea that their self-perceptions were increasing and that they wanted to continue this.

54.5% of participants stated that they honestly evaluated the benefits of what they ate and paid atten-tion to what they ate, while 38.1% of them stated that they ate whatever they liked and that they considered that this had very little effect on their performance and health.

Students tend to eat fewer fruits and vegetables on a daily basis and report high intake of high-fat, high-calorie foods (52). Sağlam (1993), in a study made with professional footballers, reported that the athletes con-sumed meat at a rate of 23.6%, chicken-fish at a rate of 4.1%, legumes at a rate of 21.4% and eggs at a rate of 51.3% daily (50). Numerous studies have shown that college students often have poor eating habits. Oth-erwise, in a study examining food consumption fre-quencies of participants who took part in the sport of bodybuilding and who used or did not use nutritional ergogenics, Özyılmaz (2013) reported that among par-ticipants who used nutritional ergogenics, 46% con-sumed chicken 4-5 times a week, 86.7% ate eggs 6-7 times a week, and 86.7% consumed milk and yoghurt once a week, while among those who did not use nu-tritional ergogenics, 53.3% consumed eggs 2-3 times a week, 66.7% ate chicken 2-3 times a week, and 53.3% consumed milk and yoghurt 2-3 times a week (53).

It was reported that 53.3% of participants con-sumed beef and lamb, cream, pies (fruit-meat), pastry, milk, cheese and fat, and that 75% of them occasionally consumed desserts and sweets (54). In Sağlam’s (1993) study, it was determined that 99.3% of footballers ate bread and 41.7% of them ate bulgur-pasta every day. In Hull and colleagues’ (2016) study, it was revealed that 49.2% of participants consumed sweet food 1-2 times within a weekday period. Moreover, in a study by

An examination of nutritional approaches and stress 7

Coutinho and colleagues (2016), it was revealed that 30% of athletes consumed sugary drinks five or more times per week (55).

It was reported that 52.8% of participants ate fi-brous foods, that 45.4% of them preferred vegetables like beans, legumes and peas as part of their diet, that 18.5% of them did not like high-fibre foods such as bread made with unsifted flour, and that 18.2% of par-ticipants only rarely used vegetables like beans, legumes and peas as part of their diet. In Hull and colleagues’ (2016) study, it was stated that 54.1% of athletes con-sumed legumes. In Coutinho and colleagues’ (2016) study, it was reported that 95% of athletes consumed legumes five or more times per week, whereas 74% of them consumed vegetables once a week or less often.

It was determined that 48.9% of participants in the study stated that they did not believe they needed to take vitamins, strength tablets and minerals and that they believed they could consume these substances with a normal diet, while almost half of them stated that they did not consider their daily nutrition to be sufficient and that they took vitamin and mineral pills.

In a study by Aljaloud and colleagues (2013), it was revealed that 6.6% of participants did not use nutritional ergogenics, while 93.3% used nutritional ergogenics (56). In Öztürk’s (2006) study, it was de-termined that the rate of using products like vitamin-mineral supplements, energy drinks and sports drinks was much lower among amateurs than among profes-sionals (57).

In a study by Braun and colleagues (2009) con-ducted on young athletes in Germany, it was reported that 80% of the athletes had used or were using dietary supplements, and that among these, the most com-monly used were mineral supplements (87%), followed by vitamins (76%), carbohydrates (64%), and protein/amino acid and fatty acid supplements (6%) (58). Das-combe and colleagues (2010) reported in their study that 87.5% of athletes used at least one form of dietary support (43.1% vitamin supplements) (59).

In the present study, 26.4% of participants ate whatever was put in front of them. 20.6% ate what they found without examining the contents. The percentage of participants eating non-fattening foods was found to be 46.7% (Table 4). Adequate and balanced nutri-tion is one of the most important factors that form the

basis of sporting success. The more an athlete acquires an adequate and balanced diet as a lifestyle and habit, the easier it becomes for that athlete to achieve the desired success (60).

College is a critical period when lifelong lifestyle habits are formed which may have a lasting impact on development of chronic diseases (55). It is reported that athletes do not have adequate dietary knowledge and that they need to be educated and made aware of matters related to basic nutrition and food groups by experts in the field of nutrition such as dieticians (61). In a study by Barr (1987) conducted with a total of 208 university students (79 sportive and 129 sedentary), it was revealed that the athletic group used nutrition sources more consciously and that their nutritional knowledge levels were higher than those of the other group (62). In Yıldırım and colleagues’ (2011) study, it was determined that nutrition education and knowl-edge levels of physical education and sports students were inadequate, that they often skipped meals, that most of the students ate only two meals, and that the rate of students having regular breakfasts was very low (63). In a study carried out on 1,455 athletes, Yüceçag and colleagues determined that athletes had dietary problems and that their knowledge of correct nutri-tion was insufficient (64). In another study in which 712 male and female university students took part, Orak and colleagues (2006) reported that the major-ity of students ate only two meals, and that they often skipped their morning meal (65). In Janout and Janou-tova’s (2004) study, it was reported that while 60.2% of students ate three meals, 33.3% of them skipped meals, and that breakfast was ranked first among the skipped meals at a rate of 62.9% (66). In a study by Güleç and colleagues (2008), it was revealed that a high per-centage of the participants skipped meals and that the most frequently skipped meal was breakfast (67). Driskell and colleagues (2005) stated that 57.11% of individuals aged 18-25 had breakfast, that 19.9% of them had morning snacks, that 87.4% had lunch, that 4.4% had elevenses, that 95% had dinner and that 72.82% ate food before going to bed at night (68). Al-though breakfast is the most often skipped meal in our country, in studies conducted with groups of adoles-cents in different countries, rates of having breakfast of 87% in Portugal, 88% in Spain, and 78% in Italy

E. Tutkun8

Table 4: Percentage distribution of responses given to nutritional approach test questionnaire% distribution

1-How would you describe yourself? Fat/thin 12.3At the correct weight for the sport played 87.7

2-How would you describe yourself according to one of the following?Eating whatever I like and believing that this has very little effect on performance and health 38.1Buying healthy food from shops, only eating natural food and sometimes dependent on various eating habits 7.4Honestly evaluating the benefits of what I eat and paying attention to what I eat 54.53-How often do you consume one or more than one of these foods in your normal diet: Beef and lamb, cream, pies (fruit or meat), pastry, milk, cheese, fat?Most days 53.5Never or rarely 7.6Occasionally or sometimes 38.94-Are you fond of desserts at mealtimes, do you use sugar and do you add this to your food?Yes- always 13.7

No- never 11.3Yes- but occasionally 755-Do you consider that you eat high-fibre foods in your diet?No- I do not like high-fibre foods like bread made from unsifted flour 18.5Yes- Because products made with flour are found in our breakfast 28.7Yes- Because we eat a number of high-fibre foods 52.86-Do you use foods such as beans, legumes and peas as part of your diet?Not really- only light foods and occasionally 18.2Basically, yes- not heavy foods but light foods 45.4Yes, often- both main meals and drinks (tea) 36.47-Do you regularly use vitamins, strength pills and drugs to meet your needs?Yes- I really believe in them and use several different kinds 17.4Yes- I use only complex vitamin supplements 33.7No- I believe that we should obtain all our nutrition from our normal diet 48.98-How often do you use suitable foods as part of your normal diet?Most of the time- I do not use frozen or processed foods 24.3

Not in the slightest- I believe that they are harmful 34.7Sometimes- Basically frozen vegetables and fish 419-Are you aware of the amount and variety of carbohydrates that you take in daily?Yes- I pay particular attention to the variety and quantity of all the carbohydrates I eat and am conscious of maintaining the necessary balance

33.1

Yes- I try to eat foods with more complex carbohydrates 28.7No- I eat whatever is in front of me without looking at the contents 38.210-Do you eat a varied and balanced diet?Yes- Always varied every week 29.2

Only for lunch; breakfast and evening meal are always the same 39.6 Only sometimes, depending on what is in the cupboard 31.211-Do you have anything to say about the food you eat?Nothing- Simply, I eat whatever is put in front of me 26.4Yes- I make do according to my and my family’s budget 26.2Yes- I choose a large part of the food that I eat 47.412- How often do you regulate your diet (such as not eating the cream of yoghurt, not eating fatty foods)?

Never- I eat food without looking at the contents 20.6Rarely- with adequate but not excess fat content or fattening food 42.7I always arrange a diet that reduces foods containing fat and increases complex carbohydrate contents 36.7

An examination of nutritional approaches and stress 9

are reported in the literature (69). Students need to be healthy, physically active, and well-nourished in order to succeed in their academic studies. Nutrition educa-tion can have a profound impact on dietary habits and food choices of many college students. Thus, college represents a key opportunity for students to learn new skills and foster healthy lifestyle practices. Students are empowered when they have the necessary knowledge and skills needed to make healthy lifestyle choices (31).

In conclusion, it was determined that the nutri-tional approaches of both male and female athletes re-ceiving sports education were good, and that as stress levels fell, nutrition scores increased. Although the athletes’ nutritional knowledge and behaviours were adequate, it is recommended that easily applicable and practical knowledge about health and stress reduction that will be beneficial for increasing life quality should be provided.

References

1. Alpar R, Ersoy G, Karagül A. Yüzücü beslenmesi el kitabı 1994; MEB Yayınları, Ankara.

2. Purcell LK Canadian Paediatric Society, Paediatric Sports and Exercise Medicine Section. Sport nutrition for young athletes. Paediatrics & child health 2013; 18 (4): 200-202.

3. Wang MQ, Perko MA, Downey GS, Yesalis CE. Changes in body size of elite high school football players, 1963–1989. Perceptual and Motor Skills 1993; 76(2): 379–383.

4. Hornstrom GR, Friesen CA, Ellery JE, Pike K. Nutrition knowledge, practices, attitudes, and information sources of mid-american conference college softball players. Food and Nutrition Science, 2011; 2(02): 109.

5. Sarıoğlu O, İmamoğlu O, Atan T, Türkmen M, Akyol P. Nutritional habits of physical education department stu-dents engaged in different sport branches, Selçuk University Journal of Physical Education and Sport Science 2012; 14 (1): 88–94

6. Shifflett B, Timm C, Kahanov L. Understanding of ath-letes’ nutritional needs among athletes, coaches, and athletic trainers. Research Quarterly for Exercise and Sport 2002; 73(3): 357–362.

7. Jessri M, Jessri M, Rashid Khani B, Zinn C. Evaluation of Iranian college athletes sport nutrition knowledge. Inter-national journal of sport nutrition and exercise metabolism 2010; 20 (3): 257-263.

8. Spendlove JK, Heaney SE, Gifford JA, Prvan T, Denyer GS, O’Connor HT. Evaluation of general nutrition knowl-edge in elite Australian athletes. British Journal of Nutrition 2012; 107 (12): 1871-1880.

9. Devlin BL, Belski R. Exploring general and sports nutrition and food knowledge in elite male Australian athletes. Inter-national journal of sport nutrition and exercise metabolism 2015; 25 (3): 225-232.

10. Cotugna N, Vickery CE, McBee S. Sports nutrition for young athletes. The Journal of School Nursing 2005; 21 (6): 323-328.

11. Galante J, Dufour G, Vainre M, Wagner AP, Stochl J, Ben-ton A, Jones PB. A mindfulness-based intervention to in-crease resilience to stress in university students (the Mind-ful Student Study): a pragmatic randomised controlled trial. The Lancet Public Health 2018; 3 (2): e72-e81.

12. Yarar H, Gökdemir K, Eroğlu H, Özdemir G. Elit se-viyedeki sporcuların beslenme bilgi ve alışkanlıklarının değerlendirilmesi. Selçuk Üniversitesi Beden Eğitimi ve Spor Bilim Dergisi 2011;13(3): 368-371.

13. Arslan SA, Daşkapan A, Çakır B. Üniversite öğrencilerinin beslenme ve fiziksel aktivite alışkanlıklarının belirlenmesi. TAF Preventive Medicine Bulletin 2016;15 (3): 171-180.

14. Von Bothmer MI, Fridlund B. Gender differences in health habits and in motivation for a healthy lifestyle among Swed-ish university students. Nursing & health sciences 2005; 7 (2): 107-118.

15. Serlachius A, Hamer M, Wardle J. Stress and weight change in university students in the United Kingdom. Physiology & Behavior, 2007; 92 (4): 548-553.

16. Cartwright M,Wardle J, Steggles N, Simon AE, Croker H, Jarvis MJ. Stress and dietary practices in adolescents. Health psychology 2003;22 (4): 362.

17. Wardle J, Steptoe, A, Oliver G, Lipsey Z. Stress, dietary restraint and food intake. Journal of psychosomatic research 2000; 48 (2): 195-202.

18. Nakao M. Work-related stress and psychosomatic medicine. Bio Psycho Social Medicine 2010; 4 (4): 2-8.

19. Deryahanoğlu G, İmamoğlu, O, Yamaner, F, Uzun, M. An-thropometric characteristics of sedentary women and com-parison of their psychological states, Journal of Human Sci-ences 2016; 13(3): 5257-5268.

20. Golden-Kreutz DM, Thornton LM, Gregorio WD, Frier-son GM, Jim HS, Carpenter KM,Andersen BL. Traumatic stress, perceived global stress, and life events:prospectively predicting quality of life in breast cancer patients. Health Psychology 2005;24 (3): 288.

21. Haidar SA, De Vries NK, Karavetian M, El-Rassi R. Stress, anxiety, and weight gain among university and college stu-dents: A systematic review. Journal of the Academy of Nu-trition and Dietetics 2018; 118 (2): 261-274.

22. Şener OA, İmamoğlu O. Feeding Approaches on The Stu-dents of Faculty of Sport Science, Internatıonal Conference on Sports for All and Wellness Books, (Editors: Süleyman Gönülateş, M.Ali Öztürk), Alanya / Turkey, 2018; 401-407.

23. Bilge A, Öğce F, Genç RE, Oran NT. Psychometrıc Proper-ties of a Turkish Version of the Perceived Stress Scale, Ege Universty Nursing College Sciences 2009; 25(2): 61-72.

24. Eskin M, Harlak H, Demirkıran F, Dereboy Ç. Algılanan stres ölçeği’nin türkçeye uyarlanması: güvenirlik ve geçerlik

E. Tutkun10

analizi. Yeni Sempozyum Derg 2013; 3(51):132-140.25. Heaney S, O’ConnorH, Michael S, Gifford J, Naughton, G.

Nutrition knowledge in athletes: a systematic review. Inter-national journal of sport nutrition and exercise metabolism 2011;21(3): 248-261.

26. Spronk I, Kullen C, Burdon C, O’Connor H. Relationship between nutrition knowledge and dietary intake. British Journal of Nutrition 2014; 111(10): 1713-1726.

27. Vançelik S, Önal SG, Güraksın A, Beyhun E. Related fac-tors with nutritional habits and nutrition knowledge of uni-versity students, tsk koruyucu hekimlik bülteni 2007; 6 (4): 242-248.

28. Ermiş E, Doğan E, Erilli N, Satıcı A. Üniversite öğrencilerinin beslenme alışkanlıklarının incelenmesi: Ondokuz Mayıs Üni-versitesi örneği, Journal of Sports and Performance Research-es 2015; 6(1): 30-40.

29. Akıl M, Gürbüz Ü. The analysıs of the level of nutrıtıon knowledge of sportsmen dealth wıth thrown branches of track and fıeld. beden eğitimi ve spor bilimleri dergisi 2010;7(1).

30. İmamoğlu O, Ağaoğlu YS, Eker H. The investigation of nutritional habits of department of physical education and sports students’ in different cities, Journal of Physical Edu-cation and Sport Science 2010; 12(4):, 1-12

31. Yahia N, Wang D, Rapley M, Dey R. Assessment of weight status, dietary habits and beliefs, physical activity, and nutri-tional knowledge among university students. Perspectives in public health 2016; 136(4): 231-244.

32. Koç K, Türkçapar Ü. Elit güreşçilerin beslenme alışkanlıkları ve beslenme destek ürünü kullanma durumlarının incelen-mesi, Akademik Sosyal Araştırmalar Dergisi 2015; 3 (21): 503-514.

33. Al-Rethaiaa AS, Fahmy AEA, Al-Shwaiyat NM. Obesity and eating habits among college students in Saudi Arabia:a cross sectional study.Nutrition journal 2010; 9(1): 39.

34. Türkmen M, İmamoğlu O. Determination of nutrition approaches in elite wrestlers, III.International Traditional Turkish Wrestling Symposium and Games Proseding Books, Kahramanmaraş 2016; 74-81.

35. Güneş Z, Ersoy G. SESAM beslenme ünitesine müracaat eden elit düzey sporcuların beslenme alışkanlıkları, kan bi-yokimya bulguları ve fiziksel özelliklerinin spor branşlarına yönelik değerlendirilmesi. Beslenme ve Diyet Dergisi 1997; 26(2): 13-18.

36. Yamak B, İmamoğlu O, Çebi M. The Effects of The Physical Fitness Levels of Adolescents on Body Image, Self-Concept And Stress Levels, The Journal of Academic Social Science 2016; 4(34): 191-201.

37. İmamoğlu O, Dilek AN, Türkmen M, Tat H. The body ımage, the level of stress and despair in the sports educated university students, 6th International Conference on Sci-ence Culture and Sport, Proceeding Books, 2018;ISBN 978-605-83344-6-5.344-352.

38. Ekici G. Yurtta kalan kız öğrencilerde beslenme alışkanlıkları ile vücut imajı, duygusal durum ve akademik başarı ilişkisi. Ergoterapi ve Rehabilitasyon Dergisi 2013; 1(2): 11-19.

39. Eker E, Şahin M, Birinci basamakta obeziteye yaklaşım. Sürekli Tıp Eğitim Dergisi 2002; 11(7): 246-249.

40. Evers C, Marijn Stok F, De Ridder DT. Feeding your feel-ings: Emotion regulation strategies and emotional eating. Personality and Social Psychology Bulletin 2010; 36 (6): 792-804.

41. Van Strien T,Cebolla A, Etchemendy E, Gutierrez-Mal-donado J, Ferrer-Garcia M, Botella C, Baños R. Emotional eating and food intake after sadness and joy. Appetite 2013; 66: 20-25.

42. Sertöz ÖÖ, Mete HE. Obezite tedavisinde bilişsel davranışçı grup terapisinin kilo verme, yaşam kalitesi ve psikopatolojiye etkileri: Sekiz haftalık izlem çalışması. Klinik Psikofarmakoloji Bülteni 2005;15:119-126.

43. Özmen D, Özmen E, Ergin D, Çakmakçi ÇA, Şen N, Er-bay DP, Taşkın EO. The association of self-esteem, depres-sion and body satisfaction with obesity among Turkish ado-lescents. BMC Public Health 2007;7 (80): 1-7.

44. Sharon HT, Sohailla DA. Preliminary survey of diet-ing, body dissatisfaction, and eating problems among high school cheerleaders. The Journal of School Health 2004;74(3): 85–91.

45. Demir BD. Liseye devam eden kız öğrencilerin beslenme alışkanlıkları ve beden algısını etkileyen etmenler. Yüksek Lisans Tezi, Hacettepe Üniversitesi Sağlık Bilimleri Fakül-tesi, Ankara 2006.

46. Erten M. Adıyaman ilinde eğitim gören üniversite öğrencilerinin beslenme bilgilerinin ve alışkanlıklarının araştırılması. Yüksek Lisans Tezi, Gazi Üniversitesi Eğitim Bilimleri Enstitüsü, Ankara 2006.

47. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L. Weight management goals and practices among U. S. high school students: Associations with physical activity, diet, and smoking. Journal of Adolescent Health 2002; 31: 133–144.

48. Örsel S, Canpolat B, Akdemir A, Özbay H. Diyet yapan ve yapmayan ergenlerin kendilik algısı, beden imajı ve be-den kitle indeksi açısından karşılaştırılması. Türk Psikiyatri Dergisi 2004; 15(1): 5-15.

49. Kaneko K, Kiriike N, Ikenaga K, Miyawaki D,Yamagami S. Weight and shape concerns and dieting behaviours among pre-adolescents and adolescents in Japan. Psychiatry and clinical neurosciences 1999; 53(3): 365-371.

50. Sağlam F. Futbolcuların Beslenme Alışkanlıkları. Spor Bil-imleri Dergisi 1993; 4(2): 27-34.

51. Papadaki A, Hondros G, Scott JA, Kapsokefalou M. Eating habits of university students living at, or away from home in Greece. Appetite 2007; 49(1): 169-176.

52. Deshpande S, Basil MD, Basil DZ. Factors influencing healthy eating habits among college students: An applica-tion of the health belief model. Health marketing quarterly 2009; 26(2): 145-164.

53. Özyılmaz C. Vücut geliştirme ve bilek güreşi federasyonu milli sporcularının, ergojenik öğe kullanımının kan para-metrelerine etkisinin saptanması. Haliç Üniversitesi Sağlık Bilimleri Enstitüsü. İstanbul. 2013; 29, 34.

54. Hull MV, Jagim AR, Oliver JM, Greenwood M, Busteed

An examination of nutritional approaches and stress 11

DR. Jones MT. Gender differences and access to a sports dietitian influence dietary habits of collegiate athletes. Jour-nal of the International Society of Sports Nutrition 2016; 13(1): 38.

55. Coutinho LA, Porto CP, Pierucci AP. Critical evaluation of food intake and energy balance in young modern pentathlon athletes: a cross-sectional study. Journal of the International Society of Sports Nutrition 2016; 13(1): 15.

56. Aljaloud SO,Ibrahim SA. Use of dietary supplements among professional athletes in Saudi Arabia. Journal of Nu-trition and Metabolism 2013;1-7.

57. Öztürk A. Profesyonel ve Amatör Futbolcuların Beslenme Alıskanlıkları ve Vücut Bileşimleri. 2006;Yüksek Lisans Tezi, Cumhuriyet Üniversitesi 2006.

58. Braun H, Koehler K, Geyer H, Kleinert J, Mester J, Schänz-er W. Dietary supplement use among elite young German athletes. International Journal of Sport Nutrition and Exer-cise Metabolism, 2009; 19(1): 97-109.

59. Dascombe BJ, Karunaratna M, Cartoon J, Fergie B, Good-man C. Nutritional supplementation habits and perceptions of elite athletes within a state-based sporting institute. Jour-nal of Science and Medicine in Sport 2010; 13(2): 274-280.

60. Ersoy G. Fiziksel uygunluk (fitness) spor ve beslenme ile ilgili temel öğretiler. Ankara: Alpofset Yayın Dağıtım 2013.

61. Bilgiç P, Hamamcılar O, Bilgiç SC. Sporcuların Beslenme Bilgi ve Uygulamaları, Beslenme ve Diyet Dergisi 2011; 39 (1-2): 37-45.

62. Barr SI. Nutrition knowledge of female varsity athletes and university students. Journal of American Diet Association 1987; 87: 1660-4.

63. Yıldırım İ, Yıldırım Y, Tortop Y, Poyraz A. Afyon Ko-catepe Üniversitesi Beden Eğitimi ve Spor Yüksekokulu öğrencilerinin beslenme alışkanlıkları ve bunları etkileyen

faktörler. Uluslararası İnsan Bilimleri Dergisi 2011; 8 (1): 1375-1390.

64. Süel E, Şahin İ, Karakaya MA, Savucu Y. Elit seviyedeki basketbolcuların beslenme bilgi ve alışkanlıkları. Fırat Üni-versitesi Sağlık Bilimleri Tıp Dergisi 2006; 20(4): 271-275.

65. Orak S, Akgün S, Orhan H. 2006 Süleyman Demirel Üniversitesi öğrencilerinin beslenme alışkanlıklarının araştırılması. S.D.Ü. Tıp Fak. Dergisi. 2016; 13(2): 5-11.

66. Janout V, Janoutova G. Eating disorders risk groups in the Czech republic cross- sectional epidemiologic pilot study. Biomed Papers 2004; 148(2): 189-93.

67. Güleç M, Yabancı N, Göçgeldi E, Bakır B. Ankara’da İki Kız Öğrenci Yurdunda Kalan Öğrencilerin Beslenme Alışkanlıkları. Gülhane Tıp Dergisi 2008; 50: 102-9.

68. Driskell JA, Kim YN, Goebel KJ. Few differences found in the typical eating and physical activity habits of lower-level and upper-level university students. Journal of The American Dietetic Association 2005; 105(5): 798-801.

69. DeJong CS, Lenthe FJ, Horst K, Oenema A. Environmen-tal and Cognitive Correlates of Adolescent Breakfast Con-sumption. Preventive Medicine 2009; 48: 372- 377.

Correspondence: Erkut TutkunFaculty of Sport Science, Uludag University16058 Nilüfer/Bursa/TurkeyTel: + 90-224-2940685Fax: + 90-224-2940997Gsm: +90-5326587696E-mail: erkuttutkun@uludag.edu.tr